The United States Senate failed to ratify The Convention for the Rights of Persons with Disabilities. It is expected to be brought back to Congress in 2013. Not sure what that is? Information can be found here: CRPD

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Work placements must reflect LRE principles, OSEP says

Schools have long understood that they must serve children with disabilities in the LRE. But they must also think about LRE when making work placements, according to OSEP.

The agency's thoughts were conveyed in a letter to three Wisconsin disability groups that had sought the agency's input in December.

"Under the IDEA, a segregated employment program may be an appropriate work placement for a particular student if determined appropriate by that student's IEP Team based on the LRE requirements and the specific individualized needs of that student," it said in Letter to Spitzer-Resnick, Swedeen, and Pugh, 112 LRP 32664 (OSEP 06/22/12). "That is, the IDEA does not prohibit segregated employment, but the LRE provisions would apply equally to the employment portion of the student's program and placement."

But it may help change the default job placement when schools are trying to help a child with a disability get some work experience, she said.

The letter "allows us to further educate parents, . . . transition teams, and school districts," she said. "It starts a conversation to say, there should be more than one work placement that is offered to a student in a district."

Hoping for more monitoring

LRE was not the only issue that OSEP addressed in its letter. In response to the questions posed by the disability groups, it also said:

· Work placements must be included in an IEP "if an IEP team determines that work placement is an appropriate transition service."

· A work placement that is listed in an IEP "becomes part of the student's educational program and part of the provision of FAPE to the student." Thus, OSEP said, "if a public agency is proposing or refusing to initiate or change a work placement that is part of a child's transition services, the public agency would be required to provide the parent with written notice, as described above, a reasonable time before the proposed placement is initiated or changed."

· The district must provide supplementary aids and services, if needed, to "enable the student to participate with other students with disabilities and nondisabled students in the work placement described in the IEP."

OSEP also addressed the issue of monitoring work placements for compliance with the principles of LRE.

"If there is evidence that a public agency makes placements that are inconsistent with [the LRE requirements at 34 CFR 300.114 ], the SEA must: (1) review the public agency's justification for its actions; and (2) assist in planning and implementing any necessary corrective action," it said.

That's important, Pugh said.

If, for example, all the transition-age students with disabilities in a given district were found to be working in segregated settings, "we're going to push for some kind of monitoring and hope that it raises red flags," she said.

"Regarding the letter from OSEP, the DPI agrees with its content (that transition services must be based on appropriate measurable post-secondary goals and that it is not appropriate to place a student automatically in a segregated community rehabilitation center)," he said in an email. "It confirms that the SEA has a responsibility to monitor an LEA if evidence exists that the LEA makes placements that are inconsistent with the provisions of IDEA."

He drew a slightly different conclusion, however, about the meaning of the letter when it comes to whether work placements are required to be listed in an IEP.

"We also believe that the letter affirms our position that a work placement does not have to be a part of an IEP," he said.

Gasper's statement may be a reference to the fact that a given student may not have a work placement, as indicated in the letter from OSEP.

"Work placement can be an appropriate transition service, depending on the individual needs of a student," it said, "but is not a required component of all IEPs that address transition services."

Justices Uphold Individual Mandate, Set Limits On Medicaid Expansion

The U.S. Supreme Court today upheld the landmark federal health law, affirming its mandate that nearly all Americans carry coverage and retaining sweeping changes to the health industry.

Chief Justice John Roberts Jr. joined the liberals on the court in upholding the mandate, deciding the penalty for not carrying insurance is a tax and therefore falls within Congress’ taxing power. But the justices voted to set limits on the law’s expansion of Medicaid, the federal state program for the poor, leaving up to states to decide whether to participate.

While the decision bolsters the Obama administration’s signature legislation, it complicates efforts to create nearly universal health coverage if states opt out of the Medicaid expansion. Many Republican governors had hoped the court would strike the Medicaid expansion.

The decision leaves intact the remainder of the 2,700 page law, which requires insurers to accept all customers regardless of their health status, provides tax credits to those who need help to buy coverage, fines some employers who don’t offer insurance and provides billions to expand Medicaid to include many people not currently covered in many states. Those provisions go into effect in 2014.

"I'm disappointed and shocked that Justice Roberts led the charge to uphold the constitutionality of the mandate and called it a tax," said Bill McCollum, who filed the first state lawsuit against the act when he was Florida's attorney general. "I certainly don't think it's a tax. It's a sad day for the American people."

Long in the making – at least five previous presidents tried and failed to pass legislation with similar aims – the law remains controversial two years after its passage.

While the ruling removes some legal uncertainties, a slew of political and technical challenges remain. The law and today’s decision are sure to feature prominently in the run-up to the November elections and the law’s fate could well hinge on the outcome. If Democrats retain the presidency and control of the Senate, implementation will likely move forward. If Republicans sweep one or both, efforts to repeal or defund are sure to gain steam. Presumptive GOP presidential nominee Mitt Romney has vowed to repeal the law if elected.

"The election is two or three times the importance of court decision," said Robert Laszewski, a consultant to the industry and former insurance executive.

While the majority opinion upheld the law’s requirement that nearly all Americans carry health coverage or pay a penalty, polls show the mandate remains hugely unpopular. Without that provision, however, most experts say that young and healthy people would forego insurance, leaving primarily sick and older people needing expensive medical care in the pool, and driving up the cost of premiums for everyone. The issue is likely to become fodder for the campaign trail.

Democrats "will try to use this to segue from 'it's legal,' to 'it's great, even the court thinks so'," said David Merritt, a senior advisor with Leavitt Partners, a health consulting firm founded by former Bush administration cabinet member Michael Leavitt.

Republicans, Merritt said, "will use it to try to raise the stakes of the election: 'This is the last chance we have to repeal this thing.'"

Florida's McCollum predicted the law's survival would energize attempts to defeat Obama in November elections and repeal it.

"If the president is re-elected, then this law will go forward," he said. "If he isn't, then I think there will be a different outcome in the health care arena."

Impact Of Medicaid Ruling

State politics, meanwhile, will come into play on the ruling on the Medicaid expansion. The ruling gives states the option not to expand eligibility without losing funding for their existing program. They would, however, lose billions in additional federal funding that would have covered newly eligible residents up to 133 percent of the federal poverty level, or about $30,000 for a family of four. Today, about 60 million people are enrolled in the program.

Sara Rosenbaum, health policy professor at George Washington University, said she expects "the overwhelming number of states" to adopt the Medicaid expansion.

"The pressure to participate will be enormous from health care providers and communities," she said. "The majority of states will not want to have its poorest residents without coverage.”

Signed into law March 23, 2010, after being passed without a single Republican vote, the health care legislation was promptly challenged, with 27 states filing or joining lawsuits challenging its constitutionality. Republicans argued the law was an overreach of federal authority and that its new taxes and fees would hurt the economy. Democrats said that slowing health care spending with provisions such as a powerful advisory board to curb Medicare costs and the so-called "Cadillac tax" on high-cost insurance benefits, would boost the economy. At the same time, the law would provide relief to millions who could not afford or qualify for insurance coverage.

The law makes few changes for people who get their coverage through their jobs, which is the main way most insured people currently receive insurance.

Most employers who provide coverage say they will not drop it in 2014, even though the $2,000 to $3,000 in penalties on those who don’t offer affordable coverage is less than what many pay for insurance.

Still, the CBO estimates that about 3 million to 5 million people who otherwise would have had employer coverage will lose it. Some of those workers will be eligible to buy insurance through new state marketplaces, some with subsidies to help them pay for it.

Implementing the law is estimated to cost about $1 trillion over nine years, much of that for the insurance subsidies and expansion of Medicaid, according to the CBO. That is slated to be paid for through savings wrung from Medicare, along with new taxes on industry and high income earners.

Gearing Up For Deadlines

The high court's decision comes a year and a half before January 2014, when some of the most significant changes called for in the law take effect. Those include the launch of new state-based marketplaces where consumers will shop for coverage, the fining of employers with 50 or more workers who fail to provide affordable coverage and the expansion of Medicaid.

But whether the federal government and the states will be able to meet the deadlines is far from certain. An estimated 17 states were awaiting today’s decision – and in some cases, the outcome of the November elections -- before moving ahead to set up the online marketplaces where consumers will shop for coverage and check eligibility for tax credits to help them buy.

States that waited for the court decision may find they have run out of time since they must submit a blueprint for the marketplaces by Nov 16.

"We could have 20 or 25 states not ready," said Laszewski.

In addition, many must resolve a host of technical challenges, including revamping aging computer systems, to prepare for increased Medicaid enrollment – and to link with federal agencies, such as the IRS, to help determine applicants’ eligibility for Medicaid or tax subsidies.

Today’s decision "doesn’t resolve any of the technical aspects the states are facing," said Joseph Antos, a health policy scholar at the conservative American Enterprise Institute.

In addition, insurers, employers and industry leaders say they don’t have all the guidelines they need from federal regulators. Federal officials, meanwhile, are navigating technical and political issues surrounding the marketplaces.

The law says the federal government will run the exchanges in states that are unable or unwilling to do so. Many policy experts say delays by governors reluctant to implement the law, coupled with technical difficulties, means that the federal government may be overseeing all or part of the vast majority of state-based marketplaces.

"The feds still have so much to do. So there’s a sigh of relief [that the court ruling was favorable] and things are moving ahead, but they’re also terrified that things are moving ahead," said Merritt at Leavitt Partners.

Health Providers Already Changing

The private sector, in contrast, has already taken significant steps.

Doctors, hospitals and insurers have begun changing the way they do business as they prepare for an influx of new customers and federal incentives aimed at slowing health care spending by rewarding increased coordination among medical providers. Some are creating so-called "medical homes," where care is coordinated and financial savings are shared among doctors, hospitals and other providers.

"The train is really well out of the station at this point," Sara Collins, a vice president at the Commonwealth Fund, a health foundation in New York City told Kaiser Health News earlier this month. "Insurance carriers are already functioning in this new world that they’re living in."

The American public, however, remains split on the law. A New York Times/CBS poll released in early June showed that two-thirds of Americans wanted the court to strike down at least part of the law, while 24 percent wanted the entire legislation kept in place. Most, however, knew little about the law’s provisions.

The court decision "is not necessarily going to make the law more popular," said Robert Blendon, Harvard professor and polling expert. "It’s almost impossible to move people’s views one way or the other."

On May 15, 2012 the U.S. Department of Education announced the release of a 40 page resource document on seclusion and restraints. U.S. Secretary of Education Arne Duncan, Special Assistant to the President for Disability Policy Kareem Dale, and U.S. Department of Education Assistant Secretary for Planning, Evaluation, & Policy Development Carmel Martin discussed the importance of this resource and corresponding principles.

The publication outlines principles for educators, parents and other stakeholders to consider when developing or refining policies and procedures to support positive behavioral interventions and avoid the use of restraint and seclusion. The resource is applicable to all students, not just those with disabilities.

This week, March 18-24, marks the 50th anniversary of National Poison Prevention Week.

For the first time in decades, poisoning surpasses motor vehicle accidents as the number one cause of injury deaths. Ninety percent of poisoning deaths are caused by drugs, including an increasing proportion of prescription painkillers.

The HRSA-funded Poison Help line, which connects callers to their local poison control centers, is a free and confidential service for everyone—kids, adults, seniors and even healthcare providers. Nurses, pharmacists, doctors and other specially trained poison experts provide consultations and treatment recommendations 24 hours a day, 7 days a week, 365 days a year, in over 150 languages and for the hearing impaired.

When it comes to poisoning prevention, don't guess, be sure. Remember this number -- Poison Help (800-222-1222). To find out more about HRSA's Poison Control Program, visit www.poisonhelp.hrsa.gov

January 19, 2012, the U.S. Department of Education’s Office for Civil Rights (OCR) released new guidance regarding the Americans with Disabilities Act Amendments Act’s impact on public elementary and secondary education programs. The Dear Colleague Letter and Questions and Answers document discuss how Section 504 and the ADAAA define disability and the obligation of school districts to evaluate students for disability, provide a free appropriate public education to students with disabilities, and provide procedural safeguards for identification, evaluation, and educational placement. See links below for further information and resources.January 19th, 2012,

We are reaching out the disability community to announce the United States Department of Transportation 2012 Summer Transportation Internship Program for Diverse Groups (STIPDG) program is open. The deadline is December 31, 2011.

The internship is a paid opportunity and will provide a life changing experience.

Idaho Parents Unlimited, Inc.

Programs and Services offered by Idaho Parents Unlimited are supported in part by the U.S. Department of Education (H328M140020) and the U.S. Department of Health and Human Services, Health Resources Services Administration (HRSA) Affordable Care Act Family to Family Health Information Center (H84MC12896), opinions expressed herein do not necessarily represent the positions of either department, endorsement is not assumed.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number and title for grant amount (specify grant number, title, total award amount and percentage financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.